Provider Demographics
NPI:1578870697
Name:PETZ, JASON ADAM (PTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ADAM
Last Name:PETZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5501 N ORACLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3829
Mailing Address - Country:US
Mailing Address - Phone:520-293-5551
Mailing Address - Fax:520-293-6638
Practice Address - Street 1:2945 W INA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2350
Practice Address - Country:US
Practice Address - Phone:520-219-5553
Practice Address - Fax:520-219-5559
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ8038A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant